Heart defects (vitia)

A congenital or acquired heart defect is a serious medical problem that should be monitored closely. Heart defects affect around 1% of all newborns worldwide, or around 800 babies a year in Switzerland, making them the most common category of birth defects.

There are different types of heart defects, with the presence of a hole in the septum between the two chambers of the heart, known as a VSD, being the most common. The most common congenital heart diseases are

Persistent Foramen Ovale (PFO)

The foramen ovale is open in all people before birth. In most people, it closes immediately after birth when the blood flows into the lungs and a connection to the left heart is no longer necessary.

In rare cases, thrombi from the venous system can enter the systemic circulation via this route in people with a patent foramen ovale (persistent foramen ovale, PFO) and cause strokes, for example.

In patients who suffer a stroke and in whom no identifiable cause other than a PFO can be detected, closure may be an appropriate therapy. This can be performed surgically (open heart surgery) or by catheterization.

The catheter procedure is performed under local anesthesia or a short general anesthetic (if a visual check using transesophageal echocardiography is necessary). A venous access is placed in the right groin and a catheter is advanced into the heart and through the opening (PFO) into the left atrium. A double umbrella (occluder) is inserted via this catheter. The first disk is unfolded in the left atrium and pulled to the septum, the second disk is unfolded on the right side of the atrium.

The correct position of the umbrella can be checked by means of transesophageal echocardiography performed at the same time. Over the course of the following months, the umbrella is overgrown by the body's own tissue. During this time, it is essential to take anticoagulant medication.

Atrial septal defect (atrial septal defect, ASD)

ASD is a congenital malformation of the heart in which the cardiac septum between the atria is not fully formed. Compared to PFO, ASD describes a larger hole in the cardiac septum between the right and left atrium.

The symptoms of an ASD depend on the size of the shunt (i.e. the amount of blood flow through the defect). Larger ASDs can cause symptoms as early as childhood (palpitations, reduced performance, frequent pulmonary infections, rarely failure to thrive). However, ASDs often remain undetected until adulthood, at which point patients are mainly characterized by cardiac arrhythmias and signs of heart failure. The treatment options are basically the same as for PFOs: depending on the size and anatomy, catheter-based closure using an umbrella occluder can be performed in many cases. Alternatively, surgical closure (open heart surgery) is an option.

Ventricular septal defect (VSD)

VSD is a heart defect in which the cardiac septum between the ventricles is not completely closed. It is the most common congenital heart defect. If the hole in the septum is large, there is a risk that blood from the left ventricle will overflow into the right ventricle and the pulmonary circulation will be overloaded by the increased blood volume.

Depending on the type, congenital VSDs can often occur with other congenital heart defects and sometimes lead to severe symptoms (cyanosis, heart failure, palpitations, failure to thrive) as early as the neonatal period, making heart surgery necessary. In the case of small isolated VSDs, however, an asymptomatic course is also possible. The defect is then often noticed during a routine check-up due to a loud heart murmur.

Rarely, VSDs can also occur as a complication of a heart attack or heart surgery and are then associated with a poor prognosis. Large VSDs are usually closed surgically with a patch, although in the case of very severe congenital defects in children or infants, palliative surgery is often the only option. Alternatively, depending on the location and size of the defect, interventional umbrella closure (similar to PFO or ASD) is also an option.

Treating heart defects with minimal intervention

Catheter technology makes it possible to treat certain heart defects with minimal intervention. This catheter procedure is not only less invasive, but also offers the advantage of a shorter recovery time for the patient. In this procedure, a special catheter, often equipped with a small camera or other medical instruments, is inserted into the bloodstream through a small incision and advanced to the heart.